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Kidney cancer

Kidney cancer (renal cancer) is a lump created by an abnormal and uncontrolled growth of cells that starts in your kidney

Kidney cancer is the eighth most common cancer in the UK. About 9,600 people are diagnosed each year. Most people who get kidney cancer are over 60 and it affects more men than women. It’s rare for people under 50 to get kidney cancer. However, a type of kidney cancer called Wilms’ tumour (also known as nephroblastoma) affects very young children.

Usually only one of your kidneys is affected. Cancer can grow through your kidney and spread to other parts of your body (through your blood or lymphatic system). Your lymphatic system is made up of the tissues and organs that produce and store cells that fight infection and disease. These include your bone marrow, spleen, thymus and lymph nodes. The spread of cancer is called metastasis.

The kidneys

You have two kidneys, which are bean-shaped organs found near the middle of your back, either side of your spine. Your kidneys are part of your urinary system. They filter your blood to remove excess water and salt as well as waste products, which are removed from your body in your urine.

Your kidneys also produce three important hormones, which are chemicals produced by your body.

Details

There are several types of kidney cancer. Renal cell cancer (RCC) is the most common in adults. More than eight in 10 people with kidney cancer in the UK have this type. In RCC, the cancerous cells are in the lining of your tubules. These are the smallest tubes inside your kidneys that help to filter your blood and make urine.

Other types of kidney cancer include the following.

Transitional cell cancer (TCC) affects part of your kidney called the renal pelvis. About eight in 100 people who get kidney cancer in the UK have TCC.

Wilms' tumour can affect children, most often those aged under five. It's different to kidney cancer in adults and is uncommon – about 70 children in the UK develop Wilms' tumour each year.

This factsheet will focus on RCC.

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Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may test a sample of your urine with a dipstick to check if there is any blood in it. He or she may also take a blood sample for testing.

Your GP may refer you to see a urologist. A urologist is a doctor who specialises in identifying and treating conditions that affect the urinary system. You may then be offered further tests, which may include the following.

Ultrasound scan. This uses sound waves to produce an image of your kidneys and can show any growths.

CT scan. This uses X-rays to make a three-dimensional image of your kidneys and the rest of your organs.

MRI scan. This uses magnets and radio waves to produce images of the inside of your kidneys.

An image-guided biopsy. In this test, your doctor will take a sample of tissue from your kidney. He or she will use an ultrasound or CT scanner to find the right area. The sample will be sent to a laboratory for testing to determine the type of cells and if these are cancerous.

If your doctor diagnoses kidney cancer, you may need further tests to find its size and exact position.

The type of treatment you have will depend on the type and size of your cancer, and whether it has spread.

Surgery

Surgery is the main treatment for kidney cancer. If kidney cancer is at an early stage, it may be possible to cure it with surgery. If your cancer has progressed, surgery can control its growth and relieve your symptoms.

Your surgeon may remove your whole kidney and nearby lymph nodes in what is called a radical nephrectomy. Alternatively, he or she may just remove the affected part of your kidney in a partial nephrectomy.

You can have open surgery, in which your surgeon will make one large cut in your abdomen (tummy). Alternatively, you may be able to have keyhole surgery.

Other surgical treatments may be suitable if you have smaller kidney tumours, or if you aren’t healthy enough to have conventional surgery. These include the following.

Percutaneous radiofrequency ablation uses heat to destroy cancer cells. You can have this under local anaesthesia. This completely blocks pain from the area around your kidney and you will stay awake during the procedure. Your surgeon will place one or more needle-like electrodes through your skin into the cancer and pass an electrical current into it. This will heat the cancer cells and destroy them. You may need to have this treatment more than once.

Cryotherapy uses very cold temperatures to destroy cancer cells. It’s usually done under general anaesthesia, which means you will be asleep during the procedure. Your surgeon will place one or more probes into the cancer and pass liquid nitrogen through them to freeze and destroy cancer cells.

High-intensity focused ultrasound uses sound waves to produce high temperatures inside cancer cells to destroy them. It may be done under local or general anaesthesia. However, this treatment is newer than other treatments, so it’s not known exactly how effective it is.

Non-surgical treatments

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. Your doctor may offer you this treatment to shrink your cancer if it’s causing you pain. You may also have it to treat cancer that has spread to other parts of your body, such as your bones or brain.

Targeted therapy

Targeted therapy (also called biological therapy) uses medicines that are designed to stop cancer cells growing. For example, they might block signals that tell cells to grow, or stop the cancer from making new blood vessels. Your doctor may offer you targeted therapy if your kidney cancer has spread or after surgery to remove your tumour. You may be invited to take part in a clinical trial of a new targeted treatment.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. Chemotherapy isn't often used to treat kidney cancer, but your doctor might offer it to you in combination with another treatment.

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Is it true that taking over-the-counter painkillers causes kidney cancer?

Answer

There is a link between taking some over-the-counter painkillers and kidney cancer. However, this link has only been found in people who take a lot of painkillers over a long period of time.

Explanation

Research into the use of painkillers and kidney cancer risk is still at an early stage. A painkiller called phenacetin was found to increase the risk of developing kidney cancer. This medicine has now been banned in the UK and many other countries.

Some over-the-counter painkillers, specifically non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, have been found to slightly increase your risk of developing kidney cancer. However, this risk only applies to you if you take a lot of these painkillers over a long period of time. It’s unlikely to be harmful if you only take painkillers occasionally or take a low dose.

If you’re taking painkillers regularly and are concerned that you may be at an increased risk of kidney cancer, speak to your GP.

What is TNM staging for kidney cancer?

Answer

The TNM staging system is a way for doctors to see how big a cancer is and how far it has spread. The tests you have to diagnose your cancer will give your doctor some information about its stage. The staging system is important because it often determines the type of treatment you will need.

Explanation

In the TNM system, the T stands for tumour, the N stands for nodes and the M stands for metastases (the spread of cancer).

T1 means your tumour is no bigger than 7cm across and is inside your kidney.

T2 means it’s larger but still within your kidney.

T3 means it has spread to tissue surrounding your kidney.

T4 means it has spread to another part of your body.

The nodes part of the system refers to the spread of cancer to your lymph nodes.

N0 means there is no cancer in any of your lymph nodes.

N1 means the cancer has spread to one of your nearby lymph nodes only.

N2 means the cancer has spread to more than one lymph node.

The metastases part of the system refers to how much the cancer has spread through your body. Cancer that has spread is called advanced kidney cancer.

M0 means the cancer hasn't spread.

M1 means your cancer has spread (metastasised).

Your doctor will combine the T, N and M stages of your tumour to give it an overall stage.

Stage 1 – your cancer is less than 7cm across and is within your kidney.

Stage 2 – your cancer is more than 7cm across, but is within your kidney.

Stage 3 – your cancer has grown into your adrenal gland or one of your major veins. There is only one nearby lymph node that contains cancer cells.

Stage 4 – your cancer has grown into surrounding tissue. There is more than one lymph node that contains cancer cells, or your cancer has spread to another part of your body.

If you would like more information or further explanation of the stage of your cancer, speak to your doctor.

What can I do to help prevent kidney cancer?

Answer

There are several changes you can make to your lifestyle to reduce your risk of developing kidney cancer. These include maintaining a healthy weight, exercising regularly, drinking alcohol in moderation and if you smoke, quitting.

Explanation

If you smoke, your risk of developing kidney cancer is double that of a person who doesn't smoke. The longer you smoke for and the more you smoke, the greater your risk. If you stop smoking, your risk of developing kidney cancer will probably decrease. There are various sources of support and advice about how to quit – ask your pharmacist or GP for advice.

If you’re overweight or obese, you’re more likely to get kidney cancer. Being overweight causes changes in your hormones (chemicals produced by your body), particularly if you’re a woman. This change in your body’s hormone balance may increase your risk of developing kidney cancer. If you're overweight, try to eat a healthy, balanced diet and take part in regular physical activity to lose excess weight.

There is still some uncertainty over the role of diet in kidney cancer. Some studies have shown that eating a diet rich in fruit and vegetables can reduce your risk. And eating large amounts of well cooked (well done) meat may increase your risk. However, there isn't enough evidence to say that this is definitely the case. Yet if you eat a healthy, balanced diet, it can lower your risk of many other diseases and generally keep you healthy.

The risk of developing kidney cancer is slightly lower in people who drink alcohol in moderation compared with people who don’t. However, drinking large amounts of alcohol increases your risk of developing several other cancers. It can also cause other medical conditions, such as high blood pressure (hypertension), which may increase your risk of kidney cancer. Try to stick to the recommended daily drinking guidelines.

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